Risk Management

When the average person encounters the term “wilderness medicine,” they typically assume it is referring to the practice of medicine in a remote or harsh environment with little to no access to medical equipment or supplies. 

They may imagine a scenario of providing CPR to someone who suffered cardiac arrest during a whitewater rafting adventure or creating a splint out of a branch and a few strands of twine to help a hiker with a sprained ankle become ambulatory. 

While these notions of wilderness medicine aren’t far off the mark, they are limited. In other words, close but no cigar. It’s all the above and more, which makes it a challenge to come up with a clear and comprehensive definition. 

Teaching Wilderness Medicine at NCOAE

Here at The National Center for Outdoor Adventure and Education (NCOAE), our wilderness medicine courses begin with a discussion of what wilderness medicine is, as well as what each student hopes to learn from the course. Often, these discussions elicit points of discussion that require an even broader definition of the term.

While there’s no universally agreed upon definition of wilderness medicine, certain components set it apart from non-wilderness medicine. For the purpose of this blog post, let’s begin with the following definition:

Wilderness Medicine is provision of medical care when environmental conditions play a stronger role in decision making and interventions than the established systems of care. 

Wilderness Medicine encompasses not only the treatment of injuries and illnesses in these settings but also includes preventive measures, survival skills, and the management of environmental hazards such as extreme weather, hazardous terrain, and wildlife encounters.

Wilderness medicine skills and techniques can be applied in a variety of setting, including but not limited to: (more…)

In the context of wilderness medicine, soap and SOAP are both indispensable. An explanation is in order. We’re all familiar with lower-case soap. This noun refers to a substance that’s added to water to remove dirt, grease, grime, and germs from various surfaces, including skin, hair, clothing, pots and pans, and so on.

Soap In The Wilderness

Traditional soap works in two ways — as a surfactant to break water tension, improving water’s ability to penetrate surfaces, and as a molecule that has a love-hate relationship with water. Soap molecules have two ends, one that’s hydrophilic (loves water) and the other that’s hydrophobic (hates water). The hydrophilic end binds to water, while the hydrophobic end binds to anything other than water — dirt, grease, grime, germs. Imagine soap molecules as tiny carabiners that shackle dirt molecules to water molecules to enable the water molecules to usher them away.

In backcountry and wilderness settings, soap plays a vital role in preventing infection and transmission of disease. In fact, scrubbing vigorously with soap and water may be among the most important risk-management technique you practice during your time in the wilderness.

SOAP (Subjective, Objective, Assessment, Plan)

Now let’s move on to the other SOAP — all uppercase — which is an acronym for Subjective, Objective, Assessment, and Plan. As an outdoor educator, field instructor, or wilderness guide, this note-taking procedure is nearly as important as scrubbing your hands regularly with soap and water. This is especially true when you’re dealing with a client injury or illness in a remote setting. 

SOAP Notes, which I’ll be covering in this post, separate important information from the chaos and fog of emotion in order to provide clean, uncluttered details for making informed medical decisions and emergency response plans. 

With SOAP Notes in hand, field instructors and outdoor educators trained in wilderness medicine, as well as backcountry guides, are better prepared to respond to a medical emergency. They do this by:

• Following an organized, methodical process
• Tracking changes in a patient’s health status
• Keeping a record of assessments, anticipated problems, and any interventions already provided
• Communicating with emergency responders
• Ensuring a seamless transfer of patient care to next-level healthcare providers
• Documenting cases and care for improving organizational outcomes

Here at The National Center of Outdoor Adventure and Education (NCOAE), we developed the SOAP Note form shown below.

Our SOAP Note’s Form

Our SOAP Note form consists of the following seven sections (more…)

In EMS (emergency medical services) education, generations of students have been taught to put safety first.  “Don’t enter a scene if it’s not safe,” is what all EMS students are told.  “Your safety is most important,” we say. “If you don’t feel safe, get out.”  

That being said, there’s another concept called “Safety Third” that’s become popular in recent years, claiming that it’s really up to the individual — not the institution — to ensure their safety on a continual basis. For more details about this, please read Safety is Third, Not First, and We All Know It Should Be in the Journal of Emergency Medical Services, written by our Medical Director, Dr. Christopher Davis, MD. 

But what is “safe” and why do we put so much emphasis on it?

Personally, I think even the notion of chatting about “safety” leads us down the wrong path. Instead, we should be discussing risk management and decision making. Let’s face it. Absolutely nothing in EMS is “safe.”  Emergency services personnel respond on a near-daily basis to situations that the regular population is unable (or unwilling) to handle.  Why, just the simple act of driving an ambulance can be unsafe.  Again, nobody becomes an EMT (Emergency Medical Technician) because they’re desperately seeking a safe career.

Most emergency healthcare providers will agree that “safety” is not really our focus. Whether they realize it or not, every EMT or paramedic who spends more than a few shifts in the field will develop their (more…)

Nobody likes to be hot and sweaty on the trail. But when things turn from being uncomfortable to becoming downright dangerous, it’s time for quick, on-the-spot emergency action. 

Heat illness is a range of medical conditions that result from the body’s inability to cope with an elevated heat load. When that occurs, it is more commonly referred to as “heat strain.” And whether you’re inactive in a warm, humid environment or participating in strenuous physical activity in the fall or winter, you are at an increased risk of heat illness.

For people who engage in backcountry adventures, heat illness and heat strain are among the many potential health and safety risks. That’s why our instructors at The National Center for Outdoor Adventure Education (NCOAE) include it in our Wilderness Medicine courses. In this post, we bring you up to speed on the basics, including the symptoms to watch for, preventive measures, and treatments to cool an overheated body.

From Bad to Worse on the Heat Illness Spectrum

Heat illness, heat strain, and related injuries occur when the core body temperature becomes elevated, stressing or surpassing the body’s ability to cool itself. Like a nuclear power plant, the human body can suffer serious and potentially fatal damage when its core becomes overheated.

The severity of the condition is on a spectrum generally divided into the following three levels: (more…)

Concussion recognition and treatment has gotten a lot of attention over the last decade, mostly in the context of youth and professional sports such as tackle football and soccer. It’s even a topic for those who serve in our armed forces. However, confusion over its prevention, diagnosis, and treatment remains widespread. 

In an interview with a reporter from the Chicago Sun Times, former National Football League quarterback Brett Favre, who was knocked out cold only once in his 20-year career, claimed that “probably 90 percent” of the tackles he endured left him with a concussion.

He’s most likely correct in that estimation. After all, the definition of “concussion” is broad: “A concussion is a brain injury, a disturbance in brain function induced by traumatic forces, either from a direct blow to the head or a transmitted force from a blow to the body.” It disrupts brain function at the cellular metabolic level but does not result in major structural damage. Conventional MRI or CT scanning will not show evidence of a concussion.

So, how do you know if you or someone else has suffered a concussion while in the backcountry? And, after having made that determination, what should be done? Having clear answers to these two questions is essential for successful recovery and to prevent long-term cognitive and psychological complications. This is true no matter where the concussion takes place, but especially in the backcountry where medical treatment from a full-time team is unavailable. (more…)

“Look where you want to go!” 

I have conveyed this message to wilderness course participants countless times, shouting, screaming, and using hand signals when necessary. Sometimes I’m yelling above the roar of a set of rapids or the sound of an adjacent waterfall. 

“Look where you want to go!”

I emphatically issue the same advice while watching climbers rappelling down a cliff, or verbally guiding a student on a mountain bike through a sketchy section of trail. In each case, the point of my shouting is to get the students to stop looking at the obstacle. 

“Look where you want to go” really translates as “Stop looking at the obstacle! Don’t fixate on the hazard!”

And it doesn’t matter if you’re a Wilderness First Responder approaching the scene of a backcountry incident, or a student on a wilderness course attempting to navigate a perceived hazard or obstacle, looking too closely at a hazard you want to avoid can be very dangerous.

At first glance — no pun intended — you might think it wise to actually look closely at the hazard you want to avoid. No argument there. You absolutely need to identify obstacles, especially in the backcountry and other places considered Wilderness. In fact, identifying an obstacle is a key factor in remaining safe. 

But here’s the thing: (more…)

Because of the situation with COVID-19, we’ve been thinking a lot lately about the path forward for outdoor and adventure-based programs like the ones we offer here at The National Center for Outdoor & Adventure Education (NCOAE). Specifically, how do we operate in a day and age where physical distancing is either required or strongly recommended? That’s where Collective Impact may come into play.

The concept of Collective Impact takes into consideration the notion that industry players need to coordinate their efforts and work together in order to create lasting solutions to shared and common societal challenges and problems.

Put simply, collective impact is a structured form of collaboration. The term garnered national recognition in 2011 when it was touted by the White House Council for Community Solutions as a powerful framework for solving social issues. The concept became so popular that “collective impact” was selected as among the top philanthropic “buzzwords” for that year.

With the current conundrum of coronavirus facing our world today, we here at NCOAE are of the opinion that solutions for COVID-19-related issues from any qualified source is worth considering. And, if you or your organization is of the same mind, we would love to hear from you. We can listen to each other’s challenges and maybe we can help each other discover solutions to those problems associated with operating an outdoor and/or adventure-based program in the time of coronavirus.

Since this crisis evolved in mid-February, we have been working up schedules and then reworking them. And, because our work crosses into many sectors — including schools, businesses, and government agencies — and because we deal with multiple states and international borders, we find ourselves dealing with a lot of moving parts.

The good news, of course, is that our staff has evolved to become a finely tuned machine. We’re able to juggle a lot and do it well. But that still leaves us wondering how the greater outdoor and adventure education industry may be grappling with the same or similar challenges as we’re contending with.

As most successful adventurers and explorers do, we set out to do some research. And here is some of what we’ve discovered so far: (more…)

Even if you’ve never participated in scouting, you probably know that “Be Prepared” is the Boy Scout Motto. It’s a maxim that still holds true for today’s outdoor enthusiasts — perhaps more so than back in 1908 when founder Robert Baden-Powell adopted it for the scouting movement.

Baden-Powell wrote that Boy Scouts in the field should consider beforehand, “any situation that might occur, so that you know the right thing to do at the right moment and are willing to do it.” He also oddly mentioned that the motto was founded on his initials (BP), but that’s neither here nor there.

The point is this. It has been estimated that more than 8 billion people visit protected “wild places” each year — areas that encompass national parks, national forests, and wildlife areas in the United States and around the world. What that means is more people are heading outdoors, which results in more people coming into direct contact with wildlife.

And that’s not always a good thing. As the signs illustrating this post show, more and more of us are introduced to the backcountry and wild places with posted warnings concerning the “fulltime residents” of these remote and natural areas.

On Cape Cod beaches, for example, there are (more…)

Here’s an outdoor educator’s nightmare: You’re walking through the woods and you spot a bunch of teens climbing barefoot on a rocky cliff leading to water. Other inexperienced campers clumsily tend a campfire that is about to get out of control. Still others in this group stand waist-deep in a river, oblivious to the fast-moving water just feet away, or the possibility of divers above them.

You look around and there doesn’t appear to be any adults, instructors or guides at this nightmarish campsite. What’s wrong with this picture?

First off, if you’re a professional outdoor educator or backcountry guide, you’re probably tempted to walk in amongst this mayhem and ask these youngsters what group they’re with and then ask them what it is they think they’re doing?

The Practice of Risk Management

Here at The National Center for Outdoor & Adventure Education (NCOAE), we take risk and site management seriously. To us, it’s far more than just a (more…)